The health care overhaul bill produced by House Democrats would impose an array of new taxes, fees and government mandates on major players in the health industry, including insurers, doctors and drugs and medical devices makers.
In most cases, the pain has been meted out with an eye toward raising the money needed to finance President Barack Obama's plan for reshaping the health system but also with careful regard for gaining the votes that will be needed to pass a final bill.
Democrats hope to vote next week on the measure, which would extend health coverage to tens of millions of Americans who don't have it, impose sweeping new restrictions on private insurers and create a government-run insurance plan to compete with them.
Among the industries targeted in the bill are medical device makers — one of the few that failed to cut an early behind-the-scenes deal with Obama and Democrats to help pay for an overhaul.
The House added $20 billion in taxes on sales of medical devices like artificial hips and heart stents to the legislation Democratic leaders unveiled Thursday. That's more than the industry wants to pay, but it's a substantial reprieve from an earlier plan in the Senate to slap a $40 billion fee on medical device makers.
Senate Majority Leader Harry Reid, D-Nev., has agreed to slash the fee, in part to win cooperation from fence-sitting Democratic Sen. Evan Bayh of Indiana.
Bayh, whose state is home to prominent medical device makers, including Zimmer Holdings, Biomet and DePuy Orthopaedics, is one of a handful of wavering Democrats whose support will be vital to getting to the 60 Senate votes necessary to advance the health overhaul.
That means he and other holdouts have disproportionate power to cut deals on behalf of favored industries that are bracing for major costs under the new system.
Stephen J. Ubl, the president of AdvaMed, the trade group representing large medical device makers, said the group appreciates House leaders' decision to include the smaller version of the tax and is "grateful for the efforts" of Bayh and others to do the same in the Senate.